Treatment Options for Patients With Prostate Cancer


A comprehensive overview of treatment options available for patients with prostate cancer and factors that influence treatment decisions.

Case #1: A 66-Year-Old-Man with Prostate Cancer

Initial Presentation (June 2022)

  • A 66-year-old man reported mild urinary frequency to his primary care physician

Clinical workup

  • After an elevated serum PSA 22 ng/mL is noted, patient presents to his urologist
  • Family history of breast cancer (patient’s mother diagnosed at age 82)
  • Digital rectal exam (DRE) unremarkable, overall physical exam unremarkable
  • MRI revealed a 40 gm prostate; no extra-prostatic extension, no nodal involvement; 1 ROI, PIRADS-5
  • Transperineal (TP) MRI fusion biopsy demonstrated prostate adenocarcinoma andGleason score 8/Grade Group 4 in 9 of 12 tissue samples and Gleason score 9/Grade Group 5 in the region of interest
  • Germline genetic testing revealed no actionable mutations; CT and bone scan revealed no extra-prostatic involvement.

Initial Treatment (starting July 2022)

  • Patient underwent robotic assisted lap radical prostatectomy (RALP) + PLND; no surgical complications
  • Pathology confirmed GG5 prostate disease with pT3bN1R1 designation
    • Positive surgical margins; 1 of 12 obturator lymph nodes were positive

12-week Follow-up Notes (October 2022)

  • Post-surgical PSA is undetectable at 12 weeks
  • Minimal GSI (<1 pad/day)
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